Provider Demographics
NPI:1689799488
Name:LOTENERO, CARRIE LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
Last Name:LOTENERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CENTER ST
Mailing Address - Street 2:UNIT 305
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4819
Mailing Address - Country:US
Mailing Address - Phone:586-202-5293
Mailing Address - Fax:
Practice Address - Street 1:19401 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2641
Practice Address - Country:US
Practice Address - Phone:313-492-9484
Practice Address - Fax:313-982-4464
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016642207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine